Healthcare Provider Details

I. General information

NPI: 1609278753
Provider Name (Legal Business Name): BRIANA BOUDREAUX BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 S CENTER VIEW CT STE 4126
WEST JORDAN UT
84084-5526
US

IV. Provider business mailing address

7533 S CENTER VIEW CT
WEST JORDAN UT
84084-5526
US

V. Phone/Fax

Practice location:
  • Phone: 801-630-2040
  • Fax: 732-813-8001
Mailing address:
  • Phone: 801-630-2040
  • Fax: 732-813-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74512
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: